Why is it important to perform a duplex scan in a patient with venous disease ?

Published: 23 January 2017

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When patients present to me with venous disease, irrespective whether the presentation is for symptomatic varicose vein disease or those with cosmetic spider veins only, we invariably perform a duplex scan.

I sometimes get questioned as to why this is necessary and so important.

The reason is that management of the venous disease depends on identifying abnormal aspects to the vein disease not able to be seen at the skin surface and responsible for the clinical or cosmetically visual problem. A person can and not uncommonly does have classic signs and symptoms of venous disease with no visible abnormality at the skin surface. The only way to accurately determine the cause of a person’s problem and the best treatment methods are by performing an ultrasound duplex scan.

Also multiple different patterns of incompetent vein disease can result in a similar appearance of abnormalities at the surface.

If vein reflux is identified and contributory to spider vein disease, then in order to get a good outcome this needs to be treated either before or in conjunction with treatment of the spider veins.Treatment decisions based solely upon clinical evaluations are often fraught with errors and often accounts for unsuccessful outcomes.

Therefore, it is imperative that all patients undergoing evaluation for lower extremity varicose or spider vein disease undergo an ultrasound study of the superficial venous system to determine the pattern or patterns of incompetence prior to making any treatment recommendations.

The goals of the ultrasound examination is to identify all incompetent truncal and other veins and to determine whether they are responsible for the patient’s clinical problem.

The ultrasound examination should be performed with the patient either near vertical or in the standing position. Generally, the examination begins at the saphenofemoral junction (SFJ) at the groin, and proceeds down to the ankle. A relatively standard protocol exists to ensure all relevant veins are examined. In addition to reflux, the truncal veins are measured as this has implications towards method of therapy. We also simultaneously examine the deep venous system as again this has implications with respect to treatment and outcomes. As the above examination takes time to perform, usually 30-60 minutes are required (one or two legs) to get an accurate complete picture

Ideally this should be performed by an expert vascular sonographer to ensure accuracy of the scan. We regularly have to repeat scans at our practice due to inadequate or incorrect studies performed elsewhere.

If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.

We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155